Comprehensive Review Flashcards

1
Q

What adverse effects are associated with the use of aminoglycosides?

A

a. Nephrotoxicity-
b. Ototoxicity
c. Neurotoxicity-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

With Nephrotoxicity with aminoglycosides there is

A

decreased creatinine clearance, casts in urine (chunks of glomerulus), decreased specific gravity, oliguria, proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

With ototoxicity with aminoglycosides there is

A

directly r/t duration > 10 days & concurrent administration of ototoxic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

With neurotoxicity with aminoglycosides there is

A

skeletal muscle weakness, inhibits pre-junctional release of Ach & decreased postsynaptic sensitivity to Ach- potentiates NMB. *Caution with Parkinson & Myasthenia
Gravis, IV Ca+ can counteract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Examples of Aminoglycosides are

A

Amikacin, Gentamicin, Neomycin Streptomycin, &

Tobramycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is common adverse reaction associated with the use of Tetracyclines? (Doxycycline, Minocycline, Demeclomycin)

A

a. Photosensitivity
b. Vestibular symptoms with MINOCYCLINE
c. Deposition in teeth in pediatrics (stains teeth permanently)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Vestibular symptoms associated with

A

minocycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the recommended time of administration of cefazolin (1st Gen) for prevention of post-op
infections?

A

a. Give pre-op in OR before induction, no sooner than 1 hour prior to procedure
b. Infuse over 3-5 min
c. <120 kg = 2 g IV, >120 kg = 3 g IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the percentage of cross reactivity between penicillins and cephalosporins?

A

a. Approximately 5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What may result if vancomycin is infused too fast?

A

a. Red Neck or Redman Syndrome

b. Clinical signs/symptoms- Histamine release (Non-Immune mediated *Barash) & hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What can prevent red neck redman syndrome with vanco

A

*Give over 60 minutes to reduce this phenomenon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What NMB can Vancomycin potentiate?

A

a. Succinylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Adverse reactions of Vancomycin?

A

a. Nephrotoxicity
b. Ototoxicity (would be at a disadvantage if we added this with an aminoglycoside)
c. Allergic Reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What antibiotics are classified as beta-lactams?

A

PCN, Cephalosporins, Imipenem/ Cilastin, Meropenem, Aztreonam is a monobactam, Carbapenems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which antibiotics are associated with prolongation of neuromuscular blockade?

A

Aminoglycosides, Polymyxin B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What antibiotics are associated with prolongation of the QTc interval?

A

Macrolides (Erythromycin, Clarithromycin, Azithromycin), Vorconazole (antifungal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
  1. What antibiotic can be used if patient has an allergy to penicillin and cephalosporin?
A

a. Aztreonam (only gram -)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some adverse reactions of Cephalosporins?

BPHRH

A

a. Bleeding (prolonged PT)
b. Hypersensitivity
c. Pseudomembranous colitis
d. Renal Impairment
e. Hepatic Impairment with Cefoperazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is an adverse reaction of Chloramphenicol?

A

a. Aplastic Anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Use of Chloremphenical is

A

Use is limited to Typhoid Fever & Salmonellosis (if alternatives are less effective)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Define zero order kinetics.

A

A fixed/constant amount of drug is eliminated/unit of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Define Hoffman degradation.

A

Spontaneous degradation via temperature & pH (Acidosis & Cold prolongs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
  1. What drugs undergo zero order kinetics?
A

a. ETOH, ASA, phenytoin, heparin, warfarin, acetaminophen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Define first order kinetics?

A

a. A percentage (%) or fraction of drug is eliminated/unit of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Define half-life.

A

a. Time it takes for plasma concentration to fall by half

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How are clearance, VD and half-life related?

A

Half-life is directly related to Vd and inversely related to clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Large volume of distribution =

A

long half-life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Increase in clearance =

A

Decrease in half-life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What opioids are most effective for the treatment of post-op shivering?

A

a. Meperidine (via Kappa), butorphanol (Stadol),

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Clonidine as far as shivering

A

effective than meperidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which narcotic agonist have the shortest effect site equilibration time?

A

a. Alfentanil (1.4 min), Remifentanil (1.1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are common adverse effects associated with the use of narcotics?

A

Respiratory depression, N/V, urinary retention, pruritus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Can exacerbate CO2 narcosis

A

Opiods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Which opioid agent can blunt the adrenal response to stress?

A

Fentanyl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q
  1. How are opioid receptors classified?
    a. Mu1 (supraspinal & spinal)-
    c. Delta (supraspinal & spinal)- antidepressant effects, physical dependence, vent depression,
    constipation (minimal), urinary retention, modulates Mu receptor activity. Agonist- enkephalins,
    no delta selective agents. Antagonists- naloxone.
    d. Kappa (supraspinal & spinal)- analgesia, sedation, dysphoria, low abuse potential, miosis,
    diuresis.
A

produces analgesia, euphoria, decreased abuse potential, miosis, urinary retention, hypothermia. Agonists- endorphins, morphine, synthetic opioids. Antagonistnaloxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Mu2 (spinal only)-

A

analgesia, hypoventilation, physical dependence physical dependence. Agonists- endorphins, morphine, synthetic opioids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Constipation (marked),

A

Mu 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Dysphoria and Diuresis with

A

Kappa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Mu 2 agonists

A

Endorphins, morphine, synthetic opioids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

OPIOID AGONIST-ANTAGONISTS principally work here. A

A

Kappa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Agonists-

A

Dynorphins (inhibit NT release via type N Ca++ channel causing analgesia, decreased resp. depression, may cause diuresis & dysphoria, increased intensity antagonist- naloxone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Painful simulation may be resistant to analgesic effects of

A

kappa receptors,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Low abuse potential which receptors

A

Kappa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Constipation (minimal)

A

Delta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Antidepressant effects,

A

Delta (supraspinal & spinal)-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Physical dependence

A

Mu2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Which induction agent is associated with increases in ICP?

A

Ketamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Which induction agent can blunt the adrenal response to stress?

A

Etomidate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Caution in adrenal insufficiency patient’s

A

Etomidate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Which induction agents possess analgesic properties?

A

Ketamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q
  1. What is the mechanisms of action of:
    Etomidate-
    e.
A

binds GABA, enhances affinity of GABA receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the mechanisms of action of Propofol?-

A

activates GABA, increases Cl ions- hyperpolarizes cell, functional inhibition, decreases rate of GABA dissociation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the mechanisms of action of Dexmedetomidine-

A

Central alpha-2 agonist (Can cause bradycardia and hypotension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the mechanisms of action of Ketamine

A

Non-competitive NMDA antagonist, weak GABA actions?, interacts with mu, delta, kappa receptors, muscarinic antagonist, K and Ca channels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is the mechanisms of action of benzo

A

Benzodiazepines- different from barbs- enhance affinity of GABA receptor for GABA, by binding/

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

The benzos increase the

A

frequency of GABA-mediated ion channel opening and increase Cl permeability and thus cause cellular hyperpolarization and inhibition of neuronal firing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Barbiturates-

A

Binds to GABA-A receptor at barb binding site and increases GABA mediated Cl influx- hyperpolarizes
cell membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Decreases dissociation of GABA, increases duration of GABA activation,

A

Barbiturates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Depresses RAS, depresses SNS transmission, decreases sensitivity of Ach receptors.

A

Barbiturates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Can cause bradycardia and hypotension

A

Dexmedetomidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What induction agent has most stable cardiovascular profile?

A

Etomidate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What induction agent increase BP, and cardiac output?

A

Ketamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Explain the physiological response to the release of thromboxane and prostacyclin?

A

a. TXA2- platelet aggregation and vasoconstriction
b. Prostacyclin- inhibits platelet aggregation & vasodilates
c. these 2 work in a balance, if one is opposed, then the other can exert it’s intrinsic properties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What agent can be used to prevent ductus arteriosus closure (Keeps the PDA patent/open)?

A

a. Alprostadil (Prostin VR, Muse, PGE1)
b. Alprostadil can also give men boners (tx erectile dysfunction if the old lady isn’t doing it for us
anymore…)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Where can we see the use of Alprostadial?

A

a. Neonatal congenital heart defects
i. Cyanotic PPTT: Pulmonary atresia, pulmonary stenosis, tricuspid atresia, Tetralogy Of Fallot
ii. Acyanotic: Coarctation of aorta, hypoplastic LV (CH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What agent can be used to close ductus arteriosis?

A

Indomethacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q
  1. What effects will each prostaglandin have on SVR?

Prostacyclin (PGI2) Epoprostenal *Flolan – *

A

Decrease SVR, Increase PVR, Decrease Platelet

Aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Epoprostenal *Flolan Treatment of

A

Primary Pulmonary HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What effects will each prostaglandin have on SVR? Alprostadil (PGE1)

A

Decrease SVR, Increases PVR, Decreases Platelet Aggregation, & Increase Uterine Tone *Keeps PFO open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What effects will each prostaglandin have on SVR? Iloporost (Nebulizer) –

A

Decrease SVR, Decrease PVR, Decrease Platelet Aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Prostaglandins use as a nebulizer

A

Iloporost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What effects will each prostaglandin have on SVR? Thromboxane (TXA2)

A

Thromboxane (TXA2) – Increase SVR, Increases PVR, & Increases Platelet aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What effects will each prostaglandin have on SVR? Dinoprost (PGF2)

A

Increase or Decrease SVR, Increase PVR, Increase Uterine Tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Increases Uterine Tone ONLY

A

Dinoprostone (PGE2) –

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

3 agents used Increase uterine tone

A

Alprostadil
Dinoprost
Dinoprotone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What prostaglandin can be used to treat refractory post-partum bleeding? What is the dose?

A

Carboprost (Hemabate) a PGF-2α that produces uterine contractions? Dose = 250 mcg IM, repeat 1.5-3.5 min intervals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Carboprost Risks of this agent-

A

vomiting, diarrhea, hyperthermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What are some characteristics of Prostaglandins?

A

a. Acidic lipids with great pharmacologic activities
b. Act as local hormones
c. Synthesized from arachidonic acid, dihydrolinoleic acid, & eicosapentaenoic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What causes the release of Arachidonic Acid?

A

Phospholipase C and A2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What drugs can we give to inhibit Phospholipase production inhibiting the Arachidonic acid pathway?

A

Corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is the half-time of Thromboxane A2?

A

30 seconds (shorter)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What is the half- time of Prostacyclin?

A

3 minutes (longer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What component of prostaglandin synthesis has Several 1000x MORE POTENT bronchial smoothmuscle vasoconstriction than Histamine?

A

a. Leukotrienes *Therefore it is important to not give asthmatic patients high dose of aspirin or NSAIDs because you can push the phospholipase pathway down the lipoxygenase path producing more leukotrienes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

All opioids antagonists

A

Narcan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What can NSAIDs do to the kidneys?

A

a. Inhibit cyclooxygenase, interfering with renal prostaglandins
b. Catecholamine induced renal vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What agents are used for cervical ripening prior to labor induction?

A

a. Dinoprostone; Cervidil, Prostin E2, Prepidil
b. Can be used during weeks 12-28 to evacuate the uterus after missed abortion or intrauterine fetal
death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What enzymes play a role in each step of prostaglandin synthesis?

A

a. Phospholipase A2 → Arachidonic Acid
i. Cyclooxygenase → Endoperoxides→
1. Thromboxane Synthetase→ Thromboxane (vasoconstriction & platelet agg.)
2. Prostacyclin Synthetase→ Prostacyclin (vasodilator & inhibits platelet agg.)
ii. Lipoxygenase → 5-hydroxyarachidonic acid→ Leukotrienes (1000x more potent
bronchoconstriction than Histamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

4What is the mechanism of action of:Cromolyn:

A

Inhibits antigen-induced release of histamine and other autocoids (leukotrienes from
pulmonary mast cells, and other tissue mast cells). basophils.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Does Cromolyn prevent release of histamine form

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Does Cromolyn relax bronchial or vascular smooth muscle

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is the mechanism of action of antihistamines?

A

competitive antagonists- occupy receptors on effector cell membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Which H2 antagonist is associated with greatest risk of CYP-450 enzyme inhibition? What can it lead to ?

A

a. Cimetidine
b. Increases plasma concentration of Propranolol, Diazepam, & Lidocaine (all have hepatic extraction ratios & depend on microenzyme metabolism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What are physiologic responses to histamine release?

H1 receptor physiologic response-

A

Smooth muscle contraction in GI and Pulmonary, induces NO release which stimulates guanylate cyclase to cause vasodilation, increase capillary permeability,
hypotension, tachycardia, flushing, headache, release of prostacyclin

94
Q

H2 receptor physiologic response

A

stimulation of gastric H+ secretion

95
Q

Increase myocardial contractility and HR

A

H2 receptor

96
Q

H3 receptor physiologic response-

A

inhibition of synthesis and release of histamine (Antagonism of H2 attenuates H3 function)

97
Q

Antagonism of H2

A

attenuates H3 function

98
Q

What is the result of blocking H2 receptor alone, followed by the administration of a histamine releasing drug?

A

An increase in release of histamine

99
Q

How do first generation antihistamines differ? What are examples of first and second generation antihistamines?

A

1st generation- more sedation, may also block muscarinic, serotonin, or alpha adrenergic (
diphenhydramine, promethazine

100
Q

What are examples of second generation antihistamines?

A

2nd generation- less sedation (fexofenadine, loratadine, cetirizine)

101
Q

Which generation antihistamine may also block muscarinic, serotonin, or alpha adrenergic?

A

1st

102
Q

Examples of first generation antihistamines are

A

Diphenhydramine

Promethazine

103
Q

Examples of 2nd generation antihistamines are

A

fexofenadine, loratadine, cetirizine)

104
Q
  1. Compare the potency of ketorolac to narcotics?
A

30 mg ketorolac IM = 10 mg morphine =100mg meperidine

105
Q

What dose of aspirin is required to inhibit the cox-1 enzyme?

A

75-325mg

106
Q

What is the recommended dose of ketorolac?

A

30 mg

107
Q

What is the recommended dose of ketorolac in a 65 y.o patient?

A

Do not exceed 30 mg in elderly for loading dose and don’t exceed 15 mg for maintenance

108
Q

What is the recommended dose of IV acetaminophen?

A

a. <50kg: 12.5mg/kg q 4 hours OR 15 mg/kg q 6h Pediatrics

b. >50kg: 650 mg q 4 hours OR 1 gram q6h

109
Q

Infusion time for IV acetaminophen (Ofirmev)?

A

Over 15 minutes

110
Q

What coagulation test can be used to monitor aspirin?

A

a. Bleeding time? prothrombin time? Platelet function?

111
Q

What is the mechanism of action of corticosteroids?

A

Block phospholipase A2 from producing arachidonic acid

112
Q

What are adverse reactions from NSAIDs?

A

a. Most common: Dyspepsia, Renal adverse effects, Peptic ulcer less common
b. Other: skin rxn, CNS effects, postop bleeding
c. Rare: blood dyscrasias, uticaria, erythema multiform, pneumonitis, aseptic meningitis

113
Q

PUD may be a side effect of ______And it is ____common

A

NSAIDS, less

114
Q

Most common side effect of NSAIDS

A

Dyspepsia

115
Q

What are the clinical properties of acetaminophen?

A

a. Mild/moderate analgesic, antipyretic, low gastric irritation & platelet aggregation
b. NO ANTI-INFLAMMATORY PROPERTIES!!!!

116
Q

What are clinical effects of aspirin?

A

Analgesic, antipyretic, platelet inhibition (for the life of the platelet ~ 7 days)

117
Q

How long should aspirin be held prior to elective surgery?

A

7-10 days

118
Q

What agents can be used to treat an acute gout attack?

A

Colchicine

119
Q

Does Tylenol have anti-inflammatory effects?

A

NO

120
Q

What are physiological effects of high and low dose aspirin?

A

a. High dose: anti-inflammatory dose 2.5-5.4 g/day

b. Low dose: MI prophylaxis 75-325 mg/day, analgesic/antipyretic 325-650 mg q 4-6 hours

121
Q

What patients are at highest risk from aspirin associated bronchospasms? What is the cause of this reaction?

A

a. Asthma pts- increases availability of arachidonic acid for production of leukotrienes

122
Q

Define the role of NSAIDs for the treatment of post-operative pain.

A

Decreases postop pain,and requirements (20-50%), not used as sole treatment,
should be combined with short-acting opioids or LA, less N/V than with opioids alone

123
Q

What are the maximum recommended doses With Epi and Without for:

A

Etidocaine- 400 mg, 300mg (Not used for spinals)

124
Q

What are the maximum recommended doses With Epi and Without for:. Bupivacaine-

A

225 mg, 175 mg

125
Q

For Bupivacaine, Intervals must be

A

> 3 hours & Max dose in 24 hrs = 400 mg

126
Q

For Bupivacine, OB continuous epidurals:

A

if 0.5% solution plain (no epi) limit dose to 320 mg

127
Q

What are the maximum recommended doses With Epi and Without for:

A

Lidocaine- 7 mg/kg (500mg total), 4.5 mg/kg (300mg total)

128
Q

What are the maximum recommended doses With Epi and Without for

A

Chloroprocaine – 14 mg/kg (1000 mg total), 11 mg/kg (800 mg total)

129
Q

What are the maximum recommended doses With Epi and Without for: Procaine

A

Procaine (Novocaine) – Max 1000 mg

130
Q

What is the maximum recommended dose of prilocaine (EMLA)?

A

a. Max 600 mg

b. O-toludine = Methemoglobin

131
Q

Which local anesthetic best demonstrates a differential block?

A

bupivacaine

132
Q

What will result when bicarbonate is added to a local anesthetic solution?

A

a. Speeds onset

b. Can form a precipitate, so need to use right away

133
Q

What effect will adding bicarbonate to LA have this have on onset of action?

A

LA will become mostly non-ionized with higher pH of surrounding solution

134
Q

What concentration of bupivacaine is not recommended by the FDA in OB?

A

0.75% = known to have CV toxicity and arrest

135
Q

Which local anesthetic has greatest cardiac toxicity?

A

Bupivicaine

136
Q

This LA is not used for spinal

A

Etidocaine

137
Q

What are signs/symptoms of CNS toxicity?

A

Circumoral numbness, lightheadedness, tinnitus, visual disturbances, slurring of speech, muscle twitching, unconsciousness, grand mal seizures, coma, apnea

138
Q
  1. What is the order of nerve blockade by local anesthetics? What are the clinical signs of the order of
    nerve blockade by local anesthetics?
    a. 1st:

c. 3
d. 4th: A-beta (sensory/proprioception, touch, pressure)
e. 5th: A-alpha (motor, skeletal muscle, proprioception)

A
B fibers, C fibers and 
A delta fibers
A gamma
A beta
A alpha
139
Q

B fibers

A

preganglionic autonomic

140
Q

A-delta

A

fast pain & temp

141
Q

C fibers

A

slow pain, temp, touch and

142
Q

Slow pain, temp, touch which fiber

A

C fibers

143
Q

Postganglionic autonomics, which fiber

A

C fibers

144
Q

A-gamma action

A

muscle tone, motor, reflexes

145
Q

A-beta

A

sensory/proprioception, touch, pressure

146
Q

A-alpha

A

motor, skeletal muscle, proprioception

147
Q

First fibers blocked

A

B fibers

148
Q

What was the first Local anesthetics

A

Cocaine

149
Q

What is a metabolite of ester local anesthetics?

A

a. Paraaminobenzoic acid (PABA)

150
Q

What is the primary determinant of the potency,of local anesthetics?

A

lipid solubility

151
Q

What is the primary determinant of onset of LA?

A

IONIZATION

152
Q

What is the primary determinant of duration of action of LA ?

A

Protein binding

153
Q

What should be done at the first sign of suspected CNS local anesthetic toxicity?

A

a. Restlessness, vertigo, tinnitus, & difficulty focusing occur initially

154
Q

Primary concern with CNS toxicity with LA

A

seizures- maintain airway and oxygenate patient

155
Q

Non-CNS LA toxicity- can have patient

A

hyperventilate

156
Q

Which local anesthetic is recommended for an emergency C-section?

A

Chloroprocaine (ester LA, least toxicity known to man, good for epidural, but NOT for spinal d/t NO plasma esterases in CSF to metabolize so it depends highly on redistribution for metabolism)

157
Q

What is the mechanism of action of local anesthetics?

A

Block fast Na channels (greater affinity for open or inactive

158
Q

2 states of Na channel LA work on

A

Open or Inactive

159
Q

What local anesthetic can cause methemoglobinemia?

A

Prilocaine, Benzocaine, Cetacaine, Lidocaine

160
Q

What are causes of increase in the minimal blocking concentration for local anesthetics?



A

Increase nerve fiber diameter, increase myelination, greater distance b/w nodes of Ranvier

161
Q

What is the diameter of each nerve fiber A-alpha:

A

15-20 microns (largest)

162
Q

What is the diameter of each nerve fiber. A-beta:

A

5-12 microns

163
Q

What is the diameter of each nerve fiber. A-gamma:

A

3-6

164
Q

What is the diameter of each nerve fiber A-delta:

A

1-4 (pain)

165
Q

What is the diameter of each nerve B fibers:

A

<3

166
Q

What is the diameter of each nerve fiber C fibers

A

0.3-1.3 (smallest) (pain)

167
Q

How many nodes of Ranvier must be blocked to inhibit nerve conduction?

A

2-3

168
Q

How are local anesthetics metabolized?Amides

A

Liver

169
Q

How are local anesthetics metabolized?Esters

A

Plasma cholinesterases

170
Q

What local anesthetics are classified as amides?

A

they all contain 2 “i” Prilocaine>etidocaine>lidocaine>mepivicaine>bupivacaine

171
Q

What local anesthetics are classified as esters?

A

They all contain 1 “i”

Chloroprocaine>procaine>tetracaine>Cocaine

172
Q

How does cocaine differ from other ester local anesthetics?

A

Vasoconstrictor, metabolized by liver & plasma esterases.

173
Q

Only ester metabolized by the liver is

A

Cocaine

174
Q

Cocaine and neurotransmitter

A

Also is a sympathomimetic increasing post-synaptic NE and; Dopamine

175
Q

Which local anesthetic can be used to treat recalcitrant (resistant) seizure activity?

A

Lidocaine

176
Q

What is recommended treatment for local anesthetic cardiac toxicity?

A

Intralipid therapy 20%

177
Q

Which local anesthetic will NOT cause vasodilatation?

A

Cocaine & Mepivacaine

178
Q

Why is epinephrine added to local anesthetic solutions? What are PROS of epinephrine use?

A

Decreases absorption of LA & prolongs the effects, decreases systemic toxicity, permits higher doses of LA

179
Q

Cons of EPI use with LA

A

Tachycardia, do not use with patient who are tachycardic?

180
Q

Know potencies of the local anesthetics.O:Water P/C

A

The higher the oil:water p.c., the more potent

181
Q

Potency of LA

A

Bupivacaine=tetracaine>ropivacaine>etidocaine>lidocaine=mepivacaine>chloroprocaine (B=
TREL=MC)

182
Q

Onset of absorption, for most to least (ITIC PEBSS)

A

IV>tracheal>intercostal>caudal>paracervical (pudendal block)>epidural>Brachial Plexus>SubArachnoid/Sciatic/Femoral>SQ (ITIC PEBSS)

183
Q

What is the selectivity in cardiac toxicity of LA?

A

a. Bupivacaine > Etidocaine > Lidocaine

184
Q

FIRST SIGN of LA toxicity

A

Circumoral numbness (mouth, lip, tongue)

185
Q

What are the 3 characteristics segments of Local anesthetics?

A
Aromatic ring (lipophillic)
Intermediate Carbon group (ester or amide) 
Tertiary amine (hydrophillic)
186
Q

What clotting factor is deficient in patients with: Hemophilia A-

A

Factor VIII deficiency

187
Q

What clotting factor is deficient in patients with:

A

Hemophilia B- Factor IX deficiency (Christmas factor)

188
Q
  1. What laboratory test are abnormal in a patient with:

a. Hemophilia A-

A

normal PT, abnormal aPTT, the specific factor assay for factor VIII will reveal
the appropriate defect. Should undergo test for vWB

189
Q

What laboratory test are abnormal in a patient with Hemophilia B-

A

normal PT, abnormal aPTT, specific assay for factor IX

190
Q

What laboratory test are abnormal in a patient with Hemophilia Bm-

A

both PT & aPTT prolonged

191
Q

How should a patient with inhibitors for factor VIII or factor IX be managed prior to elective surgery?

A

Reduce inhibitor levels with immunosuppressant therapy (cyclophosphamide), gamma-globulin, plasmapheresis, or by tolerance with high dose or frequent administration of factors

192
Q

What products are recommended for the prevention of bleeding in a patient with Von Willibrand’s
disease?

A

Cryoprecipitate, Humate-P, Koate-HS and Koate HP have been reported to achieve clinical
hemostasis prior to surgery and can be used in place of cryoprecipitate

193
Q

Goals of therapy for VWD are to

A

improve factor VIII levels, and improve bleeding time

194
Q

What is the recommended treatment for mild bleeding associated with VWB disease?

A

Desmopressin 0.3-0.4 mcg/kg, infuse over 15 minutes may be given to treat mild bleeding episodes

195
Q

What are most common adverse effects associated with desmopressin?

A

Facial flushing (most common)

196
Q

DDAVP can cause

A

platelet aggregation and severe thrombocytopenia

197
Q

DDAVP Used in type

A

IIb vWB

198
Q

Less Frequent SE of DDAVP:

A

Mild H/A, increase HR, decrease BP (you wouldn’t think), water retention which may lead to severe hyponatremia, increase plasminogen activator

199
Q

What agent can be given to inhibit the potential fibrinolysis from DDAVP?

A

Aminocarproic acid

200
Q

What is goal concentration of factor VIIIX prior to surgery?

A

Desired factor VIII levels 1 hour prior to surgery 100%, then 50% until wound healing begins, then 30% until complete would healing

201
Q

What is goal concentration of factor IX prior to surgery?

A

Half-life of factor IX is 24 hours, with normal hemostasis occurring when plasma levels area about 10-25%

202
Q

What are signs/ symptoms of Class I hemorrhage?

Class I

A

loss of up to 15% of total blood volume. Causes vasoconstriction and mild tachycardia.

203
Q

What are signs/ symptoms of Class II hemorrhage?

Class II

A

loss of 15-30% of blood volume, produces tachycardia, decreased pulse pressure,anxiety, restlessness

204
Q

Class I and II hemorrhages, How should these patients be managed?

A

IV crystalloid therapy

205
Q

What are the signs/symptoms of Class III hemorrhage?

Class III-

A

loss of 30-40%. Produces hypovolemia, marked tachycardia, systolic hypotension, AMS.

206
Q

What are the signs/symptoms of Class IV hemorrhage?Class IV

A

more than 40% of total blood volume is life threatening and accompanied by marked tachycardia and very narrow pulse pressure, and low urine output. Mental status markedly depressed.

207
Q

Class III and IV hemorrhages, How should these patients be managed?

A

In young, healthy patient, up to 30-40% of blood volume usually can be treated adequately with
crystalloid therapy

208
Q

What are the indications for the administration of platelets?
d. Determination of whether pts with intermediate (50,000-100,000) require therapy should be
based on risk of bleeding

A

Transfusion of one platelet concentrate will increase the platelet count by approximately 5,000- 10,000 in an average adult.

209
Q

Usual therapeutic dose is (for platelet)

A

1 platelet concentrate per 10kg body weight

210
Q

Prophylactic platelet transfusion

A

is rarely indicated in surgical platelet with thrombocytopenia d/t decreased platelet production when platelet count is >100,000 and is usually indicated when <50,000.

211
Q

What are the indications for administration of packed RBCs?Transfusion is rarely indicated when

A

Hgb concentration is >10g/dL

212
Q

Transfusion is Almost always indicated when it

A

is less than 6g/dL, especially when anemia is acute

213
Q

Transfusion 1 unit whole PRBCs increases

A

Hct 3% or Hgb 1g/dL, in a 70 kg non-bleeding adult

214
Q

What are the indications for the administration of FFP?

A

a. Urgent reversal of warfarin therapy

b. Microvascular bleeding with elevated PT or PTT (>1.5 times normal)

215
Q

What is the most common inheritable coagulopathy?

A

Von Willebrand Disease

216
Q

VWD Results in

A

abnormal platelet function & defective for plasma clotting

217
Q

What is VWD, needed for

A

factor VIII complex, stimulates VIII production

218
Q
  1. When should we not use DDAVP, in what type of Von Willebrand Disease?
A

Type 2B

219
Q

Can ause platelet aggregation & severe thrombocytopenia

A

DDAVAP

220
Q

Never use DDAVP in the beginning of presumed Von Willebrand Disease for this reason why?

A

because different sub-types exist and require different treatment modalities

221
Q

Relative clinical potency and BUPIVACAINE Oil/ water partition

A

8;30

222
Q

Relative clinical potency and Tetracaine Oil/ water

A

8; 80

223
Q

Relative clinical potency and Lidocaine Oil/ water partition

A

2;4

224
Q

Relative clinical potency and Mepivacaine; Oil/ water partition

A

2; 1

225
Q

Relative clinical potency and chloroprocaine; Oil/ water partition

A

1;1

226
Q

Lidocaine primary metabolite is

A

Monoethylglyceinexylidide (use to assess hepatic functions to predict morbidity and mortality)

227
Q

Prilocaine hepatic derived metabolite

A

O-Toluidine

228
Q

Define minimum blocking concentration (Cm)

A

The lowest concentration of drugs needed for blocking impulse propagation. think of it like MAC for local anesthetics

229
Q

A patient is known to be allergic to penicillin.This patient may be allergic to what other an,bio,cs?

A

Cephalosporins (Cross-reac,vity 5%) among beta-lactams

230
Q

Is there cross-sensitivity among ester local anesthetics? •

A

There is cross reactivity among ester LA. Due to common metabolite para-aminobenzoic
acid.

231
Q

Between ester and amide anesthetics?

A

No